§300gg–94 Ensuring That Consumers Get Value for Their Dollars

Summary

The law requires a yearly check on big health insurance premium hikes, starting with the 2010 plan year. Insurers must give the federal health official and the State a written reason for any unreasonable premium increase before they put it in place. Insurers must post that explanation clearly on their websites, and the federal health official will share the information with the public. States must tell the federal official about premium trends in their areas and can recommend that a State insurance marketplace (Exchange) stop letting certain insurers sell plans if they repeatedly raise rates without good reason. Starting with plan years that begin in 2014, the federal health official will watch premium increases both inside and outside Exchanges and States must consider whether prices grow faster outside the Exchange when deciding to offer large-group plans there. To help with these tasks, the federal government will give grants to States during the five-year period starting in fiscal year 2010. Grants will help review and, if allowed by State law, approve increases; give information to the federal official; and set up nonprofit or academic centers to collect and analyze medical payment data. There is $250,000,000 appropriated for these grants, and any leftover money by the end of fiscal year 2014 can be used for insurance reform work. The grant formula will consider the number of plans and State population, and no State award will be less than $1,000,000 or more than $5,000,000 in a grant year. Beginning the first fiscal year after December 29, 2022, the federal health official will also give grants to States to enforce mental health and substance use parity. States must apply and agree to collect certain analyses from insurers to be eligible. There is authorization for $10,000,000 each year for the first five fiscal years that begin after December 29, 2022. The centers must make fair fee schedules, use good statistical methods, update data, publish how they do their work, put cost information online for the public, stay free of conflicts of interest, and they cannot force insurers to give them data.